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How “talking therapies” can be measured

A method that measures the effects of talking therapies developed by researchers at Linköping University is now making a breakthrough in large parts of Sweden. With privatisation and competition comes increasing demand for methods of measuring how well various psychological therapies are working.

Rolf-HolmqvistProfessor of Psychology Rolf Holmqvist and his research team have developed a method and are now receiving major funding to disseminate it even further.

“It began as a project in primary care in Östergötland,” he explains. Psychologists and counsellors there wanted help with evaluating their work in talking therapies.

He draws a comparison with medical studies, where it is possible to randomise patients into experimental and control groups, or where neither the patient nor the doctor handling treatment are aware which patients receive the real medicines and which get a placebo. This is not possible in psychology, where treatment consists of a conversation.

“Both the patient and the therapist are aware of the method being used; this of course has an influence on expectations and probably also the outcome.

A common means of measurement is assessing the patient’s well being at the first and the last therapy sessions. However, says Holmqvist, there are a thousand reasons why the process might just fizzle out, with the measurement at the final session never taking place. The patient might not turn up, a change of therapist, or it’s just simply forgotten.

The LiU researchers therefore decided instead to conduct an evaluation before and after each therapy session. The patients who consented to taking part in the research receive a form at the reception when they arrive and another once the session is over. The questionnaire is completed and left on site. The questions on the questionnaire ask how the patients feel and their thought regarding their relationship with the therapist. The researchers also collect data from the therapist, for example about the patient being off sick from work and any medication.

“It’s a lot of paper,” Holmqvist admits, “but it works. It’s also useful to be able to be able to take measurements at each session, so that we identify changes over the course of the journey.”

The method has now been used for several years in both primary care and in Östergötland mental health care service. It has spread to other areas of Sweden including Borås, Kungälv, Värmland, Västervik and Östersund and will also start at St Göran’s Hospital and among private practitioners in Stockholm. This November Holmqvist’s research team, in conjunction with other researchers and representatives of the Swedish Association of Local Authorities and Regions (SALAR), will hold a conference with service providers where they will discuss which type of data they need in order to develop their work.

As one unit manager put it: “We want to know how successful our work is compared with others.”

“We design the questionnaires in close collaboration with the practitioners and we add questions to satisfy any particular things they wish to know.”

Data from 1,600 patients has already been collected, a figure that will now increase drastically.

What does this all tell us? What do we see?

“Talking therapies work. That’s our main finding,” Holmqvist says. “Patients in primary care clearly get much better with talking therapies. This is the case regardless of diagnosis and regardless of the kind of conversation. In the mental health care service the improvements are not as great, but there we are talking about patients afflicted with more serious diagnoses.”

The research also shows that several conversation methods return the same outcomes. For example, no great differences can be shown between CBT and psychodynamic methods. Even basic counselling works well if we take into account (or check for) which patients undergo them.

“This is the most common form of therapy and may be given to patients for whom a more advanced therapy is not warranted.”

They also looked at how many sessions are needed. Sometimes a course of therapy with a pre-arranged number of sessions, say ten, is prescribed. After that improvements are thought to diminish: the curve levels out. However Holmqvist’s team has shown that this is not the case.

“The improvement graph is not curved; it’s a straight line, which is steeper for some patients and shallower for others. This means that five sessions might be enough for some patients, while others might need fifteen or more. We can find no basis for precisely ten being best.”

Other on-going studies are looking at the relationship between therapist and patient, for example, and what happens if it deteriorates. In Borås and Kungälv, a method is being studied where feedback goes directly to the therapist and may be used in the current session.

“One of the points of our method and the large amounts of data we gather is, of course, that we can make a large number of sub-groups and study sub-issues, basically ad infinitum.

Now Holmqvist and his research team have been given another SEK 3.3 million (ca EUR 380,000) from The Swedish Council for Working Life and Social Research (FAS), to disseminate and further develop his method.


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Anika Agebjörn 2012-11-05



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Last updated: 2014-10-29